Diagnosis of the source of pain is key, is the pain arising in nerve, e.g., radiculopathy, muscle, e.g., strain injury, or joint, e.g., arthritis. Pain arising in joint is very localize, typically a few cm's surrounding the joint, and is increase by movement of the joint surfaces. With the lumbar facet this requires specific skill typically gained in chiropractic training. Statistically it is much more like that the pain arises in muscle.
Frederik,
I agree with David In as much as diagnosis is the key to determining a treatment path. Please see attached.
Regards,
Christopher
Cohen, S. P., Huang, J. H., & Brummett, C. (2013). Facet joint pain—advances in patient selection and treatment. Nature Reviews Rheumatology, 9(2), 101-116.
I'm unclear from the brevity of the question how limited the 'non-instrumented' requirement is!
I am having considerable success with the use of Platelet Rich Plasma injections placed around the facet joint (rather than within it). The method of preparation is important, and while there is no definitive evidence of the best method I would suggest using a system that removes the neutrophils since these will phagocytose the platelets and tend to be pro-inflamatory
You must understand the anatomy of the facet joint to appropriately diagnose facet syndrome. In the neck, the junction between the vertebral bodies is horizontal, so a patient becomes symptomatic when they turn their head side to side. However, the orientation of the facet joints change as you progress down the spine, so that the thoracic and lumbar facet joints are vertical and patients become symptomatic when they lean backwards, which closes the space between the joint, and irritates the disc between the facets (not the vertebral disc) and the recurrent nerve of Lushka. Identification of the symptomatic joint requires facet blocks one level above and one level below as well as at the level of the suspected pathological joint, since innervation of a single joint comes from these three levels.Pain usually is localized to the back with extension, but may radiate down the back of the leg to the knee. While a steroid injection into the joint may give a month or two of relief, Richard North, MD, PhD from Johns Hopkins Hospital found that radio frequency lesions of the three levels gave up to two years relief in 40% of the patients.
Researcher from Johns Hopkins Hospital have reported 40%-80% of chronic pain patients are misdiagnosed. They developed an Internet based "Expert System" Diagnostic Paradigm found at www.MarylandClinicDiagnostics.com. The patients answers the 72 question exam, and within 5 minutes diagnoses are sent to the treating physician which have a 96% correlation with diagnoses of Johns Hopkins Hospital dcctors. It is like getting a consult at Hopkins without the travel and expense.
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